Jennifer Tjia1,2, Celeste A Lemay2, Alice Bonner3, Christina Compher4, Kelli Paice2, Terry Field2,5, Kathleen Mazor2,5, Jacob N Hunnicutt1, Kate L Lapane1, Jerry Gurwitz2,5. 1. Division of Epidemiology, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts. 2. Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts. 3. School of Nursing, Northeastern University, Boston, Massachusetts. 4. Healthcare Management Solutions, LLC, La Vergne, Tennessee. 5. Meyers Primary Care Institute, Worcester, Massachusetts.
Abstract
OBJECTIVES: To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. DESIGN: Mixed-methods study based on semistructured interviews. SETTING: U.S. nursing homes (N = 20) from five CMS regions (III, IV, VI, VIII, IX). PARTICIPANTS: Family members of nursing home residents (N = 41). MEASUREMENTS: Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. RESULTS: Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. CONCLUSION: Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue.
OBJECTIVES: To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. DESIGN: Mixed-methods study based on semistructured interviews. SETTING: U.S. nursing homes (N = 20) from five CMS regions (III, IV, VI, VIII, IX). PARTICIPANTS: Family members of nursing home residents (N = 41). MEASUREMENTS: Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. RESULTS: Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. CONCLUSION: Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue.
Authors: Guy M McKhann; David S Knopman; Howard Chertkow; Bradley T Hyman; Clifford R Jack; Claudia H Kawas; William E Klunk; Walter J Koroshetz; Jennifer J Manly; Richard Mayeux; Richard C Mohs; John C Morris; Martin N Rossor; Philip Scheltens; Maria C Carrillo; Bill Thies; Sandra Weintraub; Creighton H Phelps Journal: Alzheimers Dement Date: 2011-04-21 Impact factor: 21.566
Authors: Dallas P Seitz; Sarah Brisbin; Nathan Herrmann; Mark J Rapoport; Kimberley Wilson; Sudeep S Gill; Jenna Rines; Ken Le Clair; David Conn Journal: J Am Med Dir Assoc Date: 2012-02-17 Impact factor: 4.669
Authors: Shannon Janzen; Aleksandra A Zecevic; Marita Kloseck; J B Orange Journal: Am J Alzheimers Dis Other Demen Date: 2013-06-27 Impact factor: 2.035
Authors: Cleusa P Ferri; Martin Prince; Carol Brayne; Henry Brodaty; Laura Fratiglioni; Mary Ganguli; Kathleen Hall; Kazuo Hasegawa; Hugh Hendrie; Yueqin Huang; Anthony Jorm; Colin Mathers; Paulo R Menezes; Elizabeth Rimmer; Marcia Scazufca Journal: Lancet Date: 2005-12-17 Impact factor: 79.321
Authors: Charlotte T M van Corven; Annemiek Bielderman; Peter L B J Lucassen; Hilde Verbeek; Ivonne Lesman-Leegte; Marja F I A Depla; Annerieke Stoop; Maud J L Graff; Debby L Gerritsen Journal: BMC Geriatr Date: 2022-03-16 Impact factor: 3.921
Authors: Anna Song Beeber; Sheryl Zimmerman; Christopher J Wretman; Stephanie Palmertree; Kush Patel; Philip D Sloane Journal: J Appl Gerontol Date: 2021-06-23